Abstract
Background and Purpose
Internationally, postoperative pancreatic fistula (POPF) remains a leading cause of morbidity and mortality after pancreaticoduodenectomy (PD). In order to reduce the incidence of POPF, a number of technical modifications for pancreato-enteric anastomosis after PD have been proposed. In 1995, we established a new technique with transpancreatic transverse U-sutures for end-to-end invaginated pancreaticojejunostomy after a PD, and the preliminary results were quite encouraging. This study aims to review a new surgical approach, the Chen’s U-stitch technique, for end-to-end invaginated pancreaticojejunostomy, which involves two to four transpancreatic transverse U-sutures, and to evaluate the effectiveness of this approach with reducing the incidence of POPF formation.
Methods
To evaluate this new approach, during 2002–2012, a total of 264 patients who received the new Chen’s U-stitch technique after a PD were included in this study. Postoperative morbidity and mortality, including the incidence of POPF, were analyzed.
Results
Postoperative morbidity was 22.3 % (59/264) and mortality was 0 % (0/264). The POPF rate was 3.4 % (9/264) for Grade A, 0.8 % (2/264) for Grade B, and 0 % (0/264) for Grade C.
Conclusions
This new surgical technique (Chen’s U-stitch), which involves an end-to-end invaginated pancreaticojejunostomy with two to four transpancreatic transverse U-sutures, provides excellent outcomes at reducing the incidence of POPF after PD.
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Acknowledgment
This work was supported by the State key project on inflectional disease of China (Grant numbers 2012ZX10002016-004 and 2012ZX10002010-001-004), the Chinese Ministry of Public Health for Key Clinical Projects (no. 439, 2010) to Professor Xiao-ping Chen.
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Single-needle U-suture technique (cartoon) (WMV 15988 kb)
Two-needle U-suture technique (cartoon) (AVI 11483 kb)
Two-needle U-suture technique (operative demonstration) (WMV 189946 kb)
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Chen, Xp., Huang, Zy., Lau, J.W.Y. et al. Chen’s U-Suture Technique for End-to-End Invaginated Pancreaticojejunostomy Following Pancreaticoduodenectomy. Ann Surg Oncol 21, 4336–4341 (2014). https://doi.org/10.1245/s10434-014-3823-2
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DOI: https://doi.org/10.1245/s10434-014-3823-2